There are two factors that may suggest myocardial ischemia. The first is the hemoglobin level, 6.9 gm/dl. The second is her symptoms, which include shortness of breath. The latter, together with angina, myocardial infarction, sudden death and rhythm disorders should be clinical clues for ischemic heart disease. The EKG, however, reveals nonspecific ST morphology. The ST segment is slightly elevated in aVR, the “cavity lead” that represents the reverse average of the electrical signals of the other five limb leads. This “minor observation” prevents the observer from ruling out pericarditis in this setting. The rhythm is sinus rhythm and the T waves do not suggest hypokalemia.